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Posts Tagged ‘Electronic Health Records’

Vendor Delays Hardship EHR Meaningful Use Implementation Standards

Monday, March 24th, 2014

CMS Recognizes Hardship Exemption From Meaningful Use Standards

meaningful use,vendor delays,cms hardshipThe American Recovery and Reinvestment Act of 2009 mandates a reduction in payments to eligible Medicare providers who have not met meaningful use standards for electronic health record technology.  Payment adjustments begin October 1, 2014, for hospitals and January 1, 2015, for Medicare eligible professionals.

CMS has created a hardship exception that permits providers to request an exemption from the payment adjustments in certain circumstances.  The hardship exemption lasts for one payment year.  A provider can be granted up to five years worth of hardship exceptions but must reapply on a yearly basis.

In order to be granted a hardship exception, providers must prove that special circumstances pose a significant barrier to their achieving meaningful use.  A few of the circumstances where hardship may be considered include the following:

  • Being located in an area without sufficient internet access or with other insurmountable infrastructure barriers.
  • Professionals who are new to the practice and who have not had time to become meaningful users can apply for a two-year limited exception to the payment adjustment rules.
  • Certain other unforeseen circumstances such as natural disasters or other unforeseeable impediments to meeting standards.

Recently, CMS added a new potential hardship for providers who are faced with EHR vendor issues.  In order to be eligible for the vendor exemption, a provider must demonstrate that circumstances are beyond its control and must explicitly outline these circumstances and indicate how they significantly impaired the ability to meet meaningful use standards.

The standards applied to receive a hardship exemption are fairly narrow and can be difficult to meet.  However, providers who see potential significant impediments to their implementation of meaningful use should begin to consider the possibility of applying for hardship exemption.  If the hardship exemption is going to be based upon EHR vendor difficulties, the implementation difficulty should be clearly documented.  At the time of application for a hardship exemption, the complete circumstances involved in the vendor relationship will need to be described to CMS.

If you have any further questions regarding electronic health record information or other health law questions, please contact John Fisher, II of our health law practice.

Electronic Health Information System Proposed Regulations Ancillary Providers

Monday, April 15th, 2013

Proposed CMS Rules Suggest Possible Future Changes To E.H.R. Donation Rules

ehr donation agreement proposed regulationsThe proposed regulations that were recently released by CMS and the OIG relating to electronic health record donations, provides a glimpse of what may be expected in the future.  Both agencies refer to concerns over “data lock” situations and donation agreements entered with clinical laboratories, DME companies, and other ancillary providers.  Although neither agency placed limitations on these arrangements in the current proposed rules, they both make it clear that they are looking closely at who should be a qualified donor under the donation regulations.

As they currently stand, the only effect of the proposed regulations would be (i) to extend the donation agreement sunshine deadline from December 31, 2013 to December 31, 2016, and (ii) to remove the requirement that software include electronic prescribing.  However, comment was solicited in other areas that make it pretty clear that we should expect the final rules to include other changes.

CMS appears to be considering what approach to take to address reports of clinical laboratories, DME providers and other ancillary providers using the Stark Law exception to enter into abusive arrangements.  CMS suggests that they may exclude certain classes of providers from being qualified donors.  They also allude to the possibility of adding an additional set of requirements to prohibit “data lock” situations.  They appear to be considering taking one or both approaches when final regulations are released.

For now, comments can be made to the proposed regulations.  Providers who have an interest in this issue might want to consider submitting comments in response to the OIG and/or CMS proposed regulations.  In the meantime, the discussions coming from the regulatory agencies cast a shadow over donation arrangements with many ancillary providers.  Even though the arrangements meet Stark Law and safe harbor provisions at the present time, it is not clear whether arrangements that are entered before the issuance of final regulations will qualify to permit extension of donation benefits beyond the first Sunset date of December 31, 2013.

Electronic Medical Record Licensing and Contracting for EHR

Friday, April 20th, 2012

EHR Licensing and Contracting Comes Center Stage

As Meaningful Use Deadlines Approach

As the meaningful use deadline approaches, many providers are scrambling to implement electronic health records.  The agreements surrounding licensing, implementation, and support of EHR systems are some of the most important agreements that a health care provider will enter.  Unfortunately, many smaller providers put little effort into negotiating terms that help assure that the product functions like it is supposed to and that the implementation takes place in a timely and efficient manner.

             We routinely become involved in the negotiation of EHR agreements.  Some of the important issues that we address include:

  •  Creating an appropriate project milestone system to assure timely project flow.
  • Coordination between vendors in multi-application systems.
  • Requiring that functional specifications are well-defined.
  • Assuring compliance with HIPAA and state laws, particularly with respect to data conversion.
  • Negotiating warranties, including meaningful use warranties.
  • Protecting against “runaway” implementation and support costs.

             The agreements relative to EHR implementation can be very complex.  Each vendor has their own license form and it can be overwhelming to work through the issues to determine how to best protect the interest of the provider.  Our experience in these issues will be a valuable resource to any provider addressing EHR implementation issues.

John H. Fisher

Health Care Counsel
Ruder Ware, L.L.S.C.
500 First Street, Suite 8000
P.O. Box 8050
Wausau, WI 54402-8050

Tel 715.845.4336
Fax 715.845.2718

Ruder Ware is a member of Meritas Law Firms Worldwide

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